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  • DOCUMENT RESUME

    ED 479 275 SP 041 690

    AUTHOR Naylor, Audrey J., Ed.; Morrow, Ardythe L., Ed.

    TITLE Developmental Readiness of Normal Full Term Infants ToProgress from Exclusive Breastfeeding to the Introduction ofComplementary Foods: Reviews of the Relevant LiteratureConcerning Infant Immunologic, Gastrointestinal, Oral Motorand Maternal Reproductive and Lactational Development.

    INSTITUTION Academy for Educational Development, Washington, DC.SPONS AGENCY Agency for International Development (IDCA), Washington, DC.

    Office of Nutrition.

    PUB DATE 2001-04-00

    NOTE 40p.; Published by Wellstart International and by LINKAGES(Breastfeeding, Complementary Feeding, and Maternal NutritionProgram). Support provided by the USAID Bureau for GlobalPrograms, Field Support and Research, Office of Health andNutrition (G/PHN/HN).

    AVAILABLE FROM LINKAGES Project, Academy for Educational Development, 1825Connecticut Avenue, N.W., Washington, DC 20009. Tel: 202 -884-8000; Fax: 202-884-8977; e-mail: linkages@aed.org; Web site:http://W'ww.linkagesproject.org. For full text:http://www.pronutrition.org/files/Developmental%20Readiness.pdf.

    PUB TYPE Collected Works General (020) Guides Non-Classroom(055)

    EDRS PRICE EDRS Price MF01/PCO2 Plus Postage.DESCRIPTORS *Breastfeeding; *Child Development; *Dietetics; Health

    Behavior; Infant Care; *Motor Development; *Nutrition;*Reproduction (Biology)

    IDENTIFIERS Gastrointestinal System; Immunology; Lactation

    ABSTRACT

    This review of the developmental readiness of normal, full-term infants to progress from exclusive breastfeeding to the introduction ofcomplementary foods is the result of the international debate regarding thebest age to introduce complementary foods into the diet of the breastfedhuman infant. After a list of definitions, four papers focus on: "ImmuneSystem Development in Relation to the Duration of ExclusiveBreastfeeding" (Armond S. Goldman); "Gastrointestinal Development in Relationto the Duration of Exclusive Breastfeeding" (W. Allan Walker); "Infant OralMotor Development in Relation to the Duration of ExclusiveBreastfeeding" (Audrey J. Naylor, Sarah Danner, and Sandra Lang); and"Maternal Reproductive and Lactational Physiology in Relation to the Durationof Exclusive Breastfeeding" (Alan S. McNeilly). (SM)

    Reproductions supplied by EDRS are the best that can be madefrom the original document.

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    Developmental Readiness ofNormal Full Term Infants toProgress from ExclusiveBreastfeeding to the Introductionof Complementary Foods

    1

    Reviews of the Relevant Literature ConcerningInfant Immunologic, Gastrointestinal, Oral Motorand Maternal Reproductive and LactationalDevelopment

    April 2001

    Audrey J. Naylor, MD, DrPH, EditorArdythe L. Morrow, PhD, Co-Editor

    PERMISSION TO REPRODUCE ANDDISSEMINATE THIS MATERIAL HAS

    BEEN GRANTED BY

    TO THE EDUCATIONAL RESOURCESINFORMATION CENTER (ERIC)

    U.S. DEPARTMENT OF EDUCATIONOffice of Educational Research and Improvement

    EDUCATIONAL RESOURCES INFORMATIONCENTER (ERIC)

    This document has been reproduced asreceived from the person or organizationoriginating it.

    Minor changes have been made toimprove reproduction quality.

    Points of view or opinions stated in thisdocument do not necessarily representofficial OERI position or policy.

    BEST COPY AVAILABLE

  • Developmental Readiness ofNormal Full Term Infants toProgress from ExclusiveBreastfeeding to the introductionof Complementary Foods

    Reviews of the Relevant Literature ConcerningInfant Immunologic, Gastrointestinal, Oral Motorand Maternal Reproductive and LactationalDevelopment

    April 2001

    Audrey J. Naylor, MD, DrPH, EditorArdythe L. Morrow, PhD, Co-Editor

    Reviews Prepared by:

    Armond S. Goldman, MDDivision of Immunology, Allergyand RheumatologyDepartment of PediatricsThe University of Texas MedicalBranchGalveston, Texas, USA

    Alan S. McNeilly, PhDMRC Human ReproductiveSciencesUniversity of EdinburghCenter for Reproductive BiologyEdinburgh, Scotland, UK

    Audrey J. Naylor, MD, DrPHWellstart InternationalSan Diego, California, USA

    W. Allan Walker, MDPediatric Gastroenterology andNutritionDepartment of PediatricsHarvard Medical SchoolBoston, Massachusetts, USA

    With Assistance from:

    Sarah Danner, MSNRapid City, South Dakota, USA

    Sandra Lang, Mphil, RM, Dip EdPreston, Lancashire, UK

    Ardythe Morrow, DrPHThe LINKAGES Project, Academy forEducational DevelopmentWashington, DC, USA

  • AID connecvngChangeChange

    USAID

    44111110,

    Technical coordination of this review was provided by Wells= International incollaboration with LINKAGES: Breastfeeding. LAM and RelatedComplementary Feeding and Maternal Nutrition Program. LINKAGES issupported by G/PHN/HN, U.S. Agency for International Development, underCooperative Agreement No. HRN-A-00-97-00007-00 and managed by theAcademy for Educational Development. The opinions expressed herein arethose of the author(s) and do not necessarily reflect the views of USAID.

    This document may be reproduced as is and in its entirety, without permission, as long thedocument gives full credit to its authors, Vv'ellstart International, the LINKAGES Project andUSAID.

    Recommended citation: Naylor AJ, ed. and Morrow A, co-ed. 2001. Developmental Readiness ofNormal Full Term Infants to Progress from Exclusive Breastfeeding to the Introduction ofComplementary Foods: Reviews of the Relevant Literature Concerning Infant Immunologic,Gastrointestinal, Oral Motor and Maternal Reproductive and Lactational Development.Wellstart International and the LINKAGES Project'Academv for Educational Development,Washington, D.C.

    The LINKAGES ProjectAcademy for Educational Development1825 Connecticut Avenue, NWWashington, DC 20009Tel: 202-884-8000Fax: 202-884-8977E-mail: linkages@aed.orgWebsite: www.linkagesproject.org

    WELLSTARTINTERNATIONAL.

    Wells= International4062 First AvenueSan Diego, CA 92103-2045Tel: 619-295-5192Fax: 619-294-7787E-mail: info@wellstartorgWebsite: www.wellstart.org

    ii BEST COPY AVAILABLE

  • Developmental Readiness of Normal Full Term Infantsto Progress from Exclusive Breastfeeding to the

    Introduction of Complementary Foods

    Reviews of the Relevant Literature Concerning InfantImmunologic, Gastrointestinal, Oral Motor and Maternal

    Reproductive and Lactational Development

    Table of Contents

    Introduction and Background1

    Specific Purpose of these Reviews2

    Process Utilized for these Reviews2

    Definitions2

    Immune System Development in Relation to the Duration ofExclusive Breastfeeding

    3Armond S. Goldman, MD

    Gastrointestinal Development in Relation to the Duration ofExclusive Breastfeeding

    13W. Allan Walker, MD

    Infant Oral Motor Development in Relation to the Duration ofExclusive Breastfeeding

    21Audrey J. Naylor, MD, DrPH with assistance of Sarah Danner and Sandra Lang

    Maternal Reproductive and Lactational Physiology in Relation to the Duration ofExclusive Breastfeeding 27Alan S. McNeil ly, PhD

    Summary and Conclusions35

    iii 5

  • Introduction and Background

    This review of the developmental readiness of normal full term infants to progress fromexclusive breastfeeding to the introduction of complementary foods has been undertaken as aresult of the international debate regarding the best age to introduce complementary (semi-solidand solid) foods into the diet of the breastfed human infant. Since 1979 the World HealthOrganization has recommended that normal full term infants should be exclusively breastfed for`four to six months" Over the two decades since this recommendation was established furtherevidence regarding the benefits of breastmilk and breastfeeding has accumulated. In addition,there have been increasing reports suggesting an association between discontinuing exclusivebreastfeeding prior to six months of age and an increase in infant morbidity and mortality.Throughout the world many professionals as well as a number of governments have concludedthat there is sufficient evidence to recommend continuing exclusive breastfeeding for "about sixmonths" Even within WHO, UNICEF and other international agencies, some documentscontinue to recommend exclusive breastfeeding for "four to six months" while others now use"about six months." There is an urgent need to review this matter and determine whether or notthere is sufficient scientific evidence to change the global recommendation. WHO responded tothis need and arranged for a review of the recent studies that relate duration of exclusivebreastfeeding ("four to six months versus six months") to infant morbidity and mortality as wellas growth and maternal health.

    Another relevant aspect of this global concern needing further attention relates to the infant'sinternal biologic processes that are proceeding along largely genetically predetermineddevelopmental pathways. These begin at the moment of conception and continue throughout life.A number of these developmental processes are important to infant feeding. The human neonateis delivered from a protected intrauterine environmentsterile, warm, and protectivefollowingnine months of development during which the nutritional, immunologic and endocrine needswere provided for by maternal systems. The newly born infant can no longer obtain fluids,nutrients, and immune protection through the umbilical cord. The ambient temperature is nolonger held at maternal body temperature and the environment is no longer sterile. Though thistransition is filled with life threatening hazards, there are many biologically active protectivesystems in place to increase the likelihood of infant survival, some within the infant and someprovided by the mother. Obvious